Review guidelines on how to code when the diagnosis isn’t definite.
Implementation of ICD-10 may have been deferred to October 2015, but the Centers for Medicare & Medicaid Services (CMS) has stepped up guidance to help you prepare for the new diagnosis coding system. Recently the agency released a transmittal that should help you understand how you’ll report these codes when insurers start requiring them next year.
CMS issued Transmittal 3020 on Aug. 8, and it announces revisions to the official ICD-10 Coding Guidelines which put them more in line with the current ICD-9 rules. For example, CMS revised the ICD-10 regs to now say, “Do not code diagnoses documented as ‘probable,’ ‘suspected,’ ‘questionable,’ ‘rule out,’ or ‘working diagnosis’ or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.”
Question: For a patient who is diagnosed with lumbar pars defect, can we report code 64493 for a lumbar pars injection? Is this the correct CPT® code?
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Here’s how to handle ROS black holes – and avoid scrutiny
There’s no question that when the physician checks the “all others negative” box for ROS elements, you can be left with less information than you’d like. Here’s the skinny on when you need more specific data and when you can let your doctor slide.
Require the Basics
If the physician doesn’t supply more information than checking the “all others negative” box, keep your eyes peeled: the systems the physician considers for the review of systems (ROS) elements can be hidden in the history of present illness (HPI) elements.
There are no numerical requirements for how many systems the physician must document in conjunction with the “all others negative” statement, and it is up to the doctor to decide how many systems are pertinent to the complaint.
The documentation guidelines simply say “positive or pertinent negative responses.”
Even dislodging the foreign body deserves a code.
The way your coding progresses in case of foreign body removal (FBR) will be dictated mainly by whether your gastroenterologist decides to removethe foreign body or simply moves it. Just follow these tips to stay abreast of the procedure codes.
Background: Although ingestion of foreign bodies is a most common occurrence in the young to very young populace, it is not rare in adults. It usually occurs accidentally but can result from deliberate ingestion. Patients with mental illness, intellectual impairment, prisoners or ‘drug-carriers,’ ‘body-packers’ (people smuggling illicit drugs concealed in their gastrointestinal tract) are prone to problems caused by purposeful ingestion of foreign bodies. Trichobezoar is a rare condition where hair ingestion leads to formation of a hairball in the stomach.
The July 2014 CPT® Assistant is brimming with updates made to the CPT® 2014 Medicine/Cardiovascular section. Find out how the introduction of several new codes in the cardiovascular section has affected the reporting of various services. You’ll increase your understanding of the changes created by revisions to codes for implantable and wearable cardiac device evaluations, injection procedures, and cardiac catheterization.
Other areas featured in the July 2014 CPT® Assistant include insights about code 92626, Evaluation of auditory rehabilitation status, and conventions of ICD-10-CM.You can use SuperCoder.com’s Code Connect code and keyword search to update your skills on the following topics:
- Auditory Rehabilitation Status Evaluation: 92590, 92601-92604, 92626-92627
- Cardiovascular Procedures/Services in Medicine Updates: 0319T-0328T, 93279-93299, 93451-93464, 93530-93533, 93561-93562, 93582
- Cine/Video Pharyngeal and Speech Evaluations and Laryngography : 70371, 70373, 74230, 92611
- Coding Correction: 27650-27654, 49650, 49659
- ICD-10-CM Conventions
The June 2014 CPT® Assistant guides you through the implementation of CPT®category III adaptive behavior assessment and treatment codes and guidelines on July 1, 2014. You’ll come across a list of guiding principles that led to the development of assessment and treatment codes by a panel of members representing psychiatry, clinical social workers, behavioral analysts, payers, and many more to help you better understand and apply these codes. Be sure you don’t miss out on the assessment codes that enable the provider to identify adaptive behavior treatment and developing a plan of care.
Other areas featured in the June 2014 CPT® Assistant include active wound care management through low frequency ultrasound and conventions of ICD-10-CM. You can use SuperCoder.com’s Code Connect code and keyword search to update your skills on the following topics:
- Active wound-care management: low-frequency ultrasound: 97597, 97598, 97602, 97610, 0183T
- Adaptive behaviour assessments and treatment: 90791, 90792, 90834, 90853, 92508, 92521-92524, 96101, 96110, 96116, 96118, 96150-96155, 97003, 97004, 99366-99368, 99487-99489, 0359T-0374T, H2001, H2010-H2014, H2019, H2020
- Conventions of ICD-10-CM.
Starting next year, the single code for reflux expands into two separate choices.
Esophageal reflux can occur at all ages, but the condition “is common and often overlooked in children,” according to the Pediatric/Adolescent Gastroesophageal Reflux Association. If you see this common condition in your practice, get to know how the coding will change next year under ICD-10.
ICD-9 Coding Rules: Under the ICD-9 code set, if you see a pediatric patient and diagnose her with esophageal reflux, you currently report 530.81 (Esophageal reflux) for the visit.
Question: We had a case where the surgeon had to “redo” an old fundoplication while performing a laparoscopic hiatal hernia repair with placement of Sirgisis mesh. How should we code this, and can we separately report the fundoplication?
Plus: You could see moderate sedation changes in January.
The potential updates to Medicare’s global period rules (see the Insider Vol. 15 no. 25) are just the tip of the iceberg when it comes to the Proposed Medicare Physician Fee Schedule that CMS published last week. There are also specific coding changes that the agency has proposed which could impact the way you code your services, CMS reps said during a July 11 CMS Open Door Forum regarding the 2015 proposed fee schedule.
The following highlights reveal some possibilities that could be in the pipeline for your Medicare payments.
Enhanced efficiency may tilt the scales toward early transition.
Training your staff members about ICD-10 codes and updating your software to handle the new diagnoses is a great start to your ICD-10 transition plan, but the job isn’t completed just yet. There are a few additional steps that you’ll need to take between now and the new implementation date, experts said during CMS’s March 13 webinar, “ICD-10 Overview: Basics and Transition Tips.
Keep An Eye on ‘Non-covered’ Entities